Trong nhi\u1ec1u tr\u01b0\u1eddng h\u1ee3p, c\u00e1c b\u00e1c s\u0129 v\u1eabn g\u1eb7p kh\u00f3 kh\u0103n trong vi\u1ec7c t\u00ecm th\u1eddi \u0111i\u1ec3m th\u00edch h\u1ee3p \u0111\u1ec3 b\u1eaft \u0111\u1ea7u s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p thay th\u1ebf th\u1eadn (RRT) cho b\u1ec7nh nh\u00e2n h\u1ed3i s\u1ee9c t\u00edch c\u1ef1c (ICU). L\u01b0\u1ee3ng y v\u0103n tuy ng\u00e0y c\u00e0ng nhi\u1ec1u nh\u01b0ng l\u1ea1i \u0111\u01b0a ra nh\u1eefng k\u1ebft qu\u1ea3 r\u1ea5t kh\u00e1c nhau. C\u00e1c nghi\u00ean c\u1ee9u n\u0103m 2018 t\u1eadp trung v\u00e0o nh\u1eefng nh\u00f3m b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3 n\u00e0y \u0111\u00e3 \u0111\u01b0\u1ee3c Editor c\u1ee7a t\u1ea1p ch\u00ed NEJM t\u1ed5ng k\u1ebft \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 li\u1ec7u thu h\u1eb9p ph\u1ea1m vi ti\u1ebfp c\u1eadn RRT c\u00f3 \u0111\u01b0a ra \u0111\u01b0\u1ee3c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ee5 th\u1ec3 hay kh\u00f4ng.<\/p>\n
\u1ede m\u1ed9t th\u1eed nghi\u1ec7m tr\u01b0\u1edbc \u0111\u00e2y, b\u1ec7nh nh\u00e2n ICU c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p t\u00ednh (AKI giai \u0111o\u1ea1n 3, \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh b\u1eb1ng n\u1ed3ng \u0111\u1ed9 creatinine huy\u1ebft thanh v\u00e0 l\u01b0\u1ee3ng n\u01b0\u1edbc ti\u1ec3u), c\u1ea7n th\u1edf m\u00e1y ho\u1eb7c s\u1eed d\u1ee5ng thu\u1ed1c co m\u1ea1ch \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn ng\u1eabu nhi\u00ean \u0111\u1ec3 s\u1eed d\u1ee5ng li\u1ec7u ph\u00e1p RRT s\u1edbm ho\u1eb7c mu\u1ed9n, c\u00f3 c\u00e1c ti\u00eau ch\u00ed c\u1ee5 th\u1ec3 \u0111\u1ec3 tr\u00ec ho\u00e3n RRT (NEJM JW Gen Med ng\u00e0y 15\/7 2016 v\u00e0 N Engl J Med 2016 ng\u00e0y 14\/7; 375:122). N\u0103m 2018, m\u1ed9t ph\u00e2n t\u00edch h\u1eadu ki\u1ec3m (post hoc) cho th\u1eed nghi\u1ec7m tr\u00ean t\u1eadp trung v\u00e0o nh\u00f3m b\u1ec7nh nh\u00e2n c\u1ee5 th\u1ec3 c\u00f3 shock nhi\u1ec5m khu\u1ea9n v\u00e0 suy h\u00f4 h\u1ea5p c\u1ea5p (ARDS). K\u1ebft qu\u1ea3 ph\u00e2n t\u00edch t\u01b0\u01a1ng t\u1ef1 nhau \u1edf c\u1ea3 2 nh\u00f3m, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0o gi\u1eefa d\u00f9ng RRT s\u1edbm v\u00e0 mu\u1ed9n \u1edf c\u00e1c ti\u00eau ch\u00ed: th\u1eddi gian ng\u1eebng th\u1edf m\u00e1y, th\u1eddi gian n\u1eb1m vi\u1ec7n v\u00e0 t\u1ec9 l\u1ec7 t\u1eed vong trong 60 ng\u00e0y (NEJM JW Gen Med ng\u00e0y 15\/8 v\u00e0 Am J Respir Crit Care Med ng\u00e0y 1\/7; 198:58). Nh\u1eefng k\u1ebft qu\u1ea3 tr\u00ean t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi k\u1ebft qu\u1ea3 \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 cho to\u00e0n b\u1ed9 qu\u1ea7n th\u1ec3 nghi\u00ean c\u1ee9u.<\/p>\n
Trong m\u1ed9t th\u1eed nghi\u1ec7m m\u1edbi n\u0103m 2018, 488 b\u1ec7nh nh\u00e2n c\u00f3 shock nhi\u1ec5m khu\u1ea9n v\u00e0 AKI \u0111\u01b0\u1ee3c ph\u00e2n nh\u00f3m ng\u1eabu nhi\u00ean \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p thay th\u1ebf th\u1eadn s\u1edbm ho\u1eb7c mu\u1ed9n h\u01a1n 48 ti\u1ebfng (tr\u1eeb tr\u01b0\u1eddng h\u1ee3p c\u00f3 d\u1ea5u hi\u1ec7u h\u1ed3i ph\u1ee5c ch\u1ee9c n\u0103ng th\u1eadn r\u00f5 r\u00e0ng). Th\u1eed nghi\u1ec7m n\u00e0y \u0111\u00e3 k\u1ebft th\u00fac s\u1edbm do kh\u00f4ng \u0111em l\u1ea1i l\u1ee3i \u00edch. M\u1ed9t l\u1ea7n n\u1eefa, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0o trong t\u1ec9 l\u1ec7 t\u1eed vong gi\u1eefa 2 nh\u00f3m. \u0110\u00e1ng ch\u00fa \u00fd l\u00e0 ch\u1ec9 c\u00f3 62% b\u1ec7nh nh\u00e2n \u1edf nh\u00f3m \u0111i\u1ec1u tr\u1ecb mu\u1ed9n th\u1ef1c hi\u1ec7n RRT (NEJM JW Gen Med ng\u00e0y 1\/12 v\u00e0 N Engl J Med 11\/10; 379:1431).<\/p>\n
Th\u1eed nghi\u1ec7m th\u1ee9 3 t\u1eadp trung v\u00e0o nh\u00f3m b\u1ec7nh nh\u00e2n nguy k\u1ecbch nhi\u1ec5m toan chuy\u1ec3n h\u00f3a, g\u1ea7n m\u1ed9t n\u1eeda trong s\u1ed1 \u0111\u00f3 c\u00f3 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p t\u00ednh. B\u1ec7nh nh\u00e2n nhi\u1ec5m toan chuy\u1ec3n h\u00f3a nghi\u00eam tr\u1ecdng (pH \u2264 7,2; bicarbonate \u2264 20 mmol\/l; ph\u00e2n su\u1ea5t CO2 \u2264 45 mmHg) \u0111\u01b0\u1ee3c cho truy\u1ec1n d\u1ecbch NaHCO3 4,2% ho\u1eb7c kh\u00f4ng \u0111i\u1ec1u tr\u1ecb g\u00ec. M\u1eb7c d\u00f9 t\u1ec9 l\u1ec7 t\u1eed vong l\u00e0 kh\u00e1c bi\u1ec7t gi\u1eefa 2 nh\u00f3m, \u0111i\u1ec3u tr\u1ecb b\u1eb1ng RRT v\u1eabn l\u00e0 li\u1ec7u ph\u00e1p ph\u1ed5 bi\u1ebfn \u1edf nh\u00f3m \u0111\u1ed1i ch\u1ee9ng so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng bicarbonate (NEJM JW Gen Med ng\u00e0y 1\/9 and v\u00e0 Lancet ng\u00e0y 7\/7; 392:31).<\/p>\n
Nh\u1eefng nghi\u00ean c\u1ee9u tr\u00ean kh\u00f4ng ch\u1ee9ng minh \u0111\u01b0\u1ee3c l\u1ee3i \u00edch r\u00f5 r\u00e0ng n\u00e0o c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng RRT s\u1edbm \u1edf b\u1ec7nh nh\u00e2n shock nhi\u1ec5m khu\u1ea9n v\u00e0 ARDS. Vi\u1ec7c tr\u00ec ho\u00e3n s\u1ebd gi\u00fap m\u1ed9t nh\u00f3m b\u1ec7nh nh\u00e2n tr\u00e1nh \u0111\u01b0\u1ee3c RRT ho\u00e0n to\u00e0n. V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n m\u00e0 ch\u1ec9 \u0111\u1ecbnh l\u1ecdc m\u00e1u ch\u00ednh l\u00e0 do nhi\u1ec5m toan chuy\u1ec3n h\u00f3a, truy\u1ec1n bicarbonat c\u00f3 th\u1ec3 c\u0169ng gi\u00fap tr\u00ec ho\u00e3n RRT.<\/p>\n